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PubMedDate not supplied

Outcome of patients with hepatitis C virus-related hepatocellular carcinoma occurring after interferon therapy.

To determine whether previous IFN therapy for chronic hepatitis C (HCV) infection influences the outcome of patients with hepatocellular carcinoma (HCC), 143 patients were enrolled in this study. Of 143 patients, 48 had received previous IFN therapy (IFN group) and the remaining 95 had not (untreated group). We estimated distant intrahepatic recurrence-free intervals and disease-specific survivals of the two groups by the Kaplan-Meier method and analyzed the difference by the log-rank test. Factors determining distant intrahepatic recurrence-free interval and disease-specific survival were studied by univariate and multivariate analysis using Cox proportional hazards regression model. The proportion of patients with single tumors was significantly higher in the IFN group (p = 0.026). The IFN group showed a significantly higher distant intrahepatic recurrence-free interval (p = 0.001) and disease-specific survival (p = 0.003). Moreover, multivariate analysis indicated that previous IFN therapy for chronic HCV infection was a significant independent factor for distant intrahepatic recurrence-free interval and disease-specific survival. These results indicate that previous IFN therapy reduces multicentric hepatocarcinogenesis of HCV-related HCC and improves the patients' survival.

Aged↗
PubMed2003

[New therapeutic strategies for Hodgkin lymphoma in cooperation of radiation oncology and medical oncology].

BACKGROUND: Between 1984 and 2002 more than 9500 pts. were enrolled in the multicentric randomized trials of the German Hodgkin Study Group (GHSG) and are evaluable for response, survival, recurrences, and toxicities. Actually the GHSG evaluates the efficacy of risk-adapted therapy composed of polychemotherapy (CT) and radiotherapy (RT). An extensive RT quality assurance program has been practiced during the study generations and will be continued. PATIENTS AND METHODS: The 4th study generation (1998-2002) includes the following trials: In the HD10 trial (early stages) 4x ABVD are tested against 2x ABVD followed by 20 Gy Involved Field (IF)-RT vs. 30 Gy IF-RT (4 arms). In order to optimize CT-regimen and IF-RT dose for pts. with intermediate stage, the HD11 trial compares 4x ABVD with 4x BEACOPP baseline followed by 20 Gy IF-RT vs. 30 Gy IF-RT in a 4 arm design. Concerning advanced stages (HD12), the BEACOPP regimen is to be optimized and the necessity of additive RT is tested. The standard arm (8x BEACOPP escalated) is compared with the toxicity reduced arm (4x BEACOPP escalated + 4x BEACOPP baseline) followed by 30 Gy RT on initial bulky disease and/or residual tumor vs. no RT (4 arms). RESULTS: Interim results (without arm comparisons) with a median follow-up of 18 months for HD10 and HD11 and 20 months for HD12 are as follows: Freedom from Treatment Failure (FFTF) at 18 months is in the HD10 trial (390 pts.) 96.4%, in the HD11 trial (480 pts.) 91.5% and in the HD12 trial (550 pts.) 90.2%.The overall survival (OS) at 18 months is in HD10 98.2%, in HD11 98.5%, in HD12 93.5%. In HD10, HD11 and HD12 respectively, 1.8%, 1.9% and 2.5% of pts. died and 1.0%, 2.5% and 2.2% suffered early progression. CONCLUSION/FURTHER STRATEGY: In order to reduce the relapse rate and toxicity and to improve the quality of life, the new HD13 trial for early stages (Fig. 1a) compares 2x ABVD, 2x ABV, 2x AVD und 2x AV, each followed by 30 Gy IF-RT. For the intermediate stages, the FFTF rate should be improved by intensifying the standard regimen. Therefore the new trial HD14 (Fig. 1b) compares 4x ABVD with 2x BEACOPP escalated + 2x ABVD, each followed by 30 Gy IF-RT. In the new trial for advanced stages HD15 (Fig. 1c),the FFTF/OS rates are to be maintained and the quality of life to be improved. 8x BEACOPP escalated, 6x BEACOPP escalated and 8x BEACOPP baseline with shortened 14-day cycle are compared. The use of PET to decide on additive RT will also be investigated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

[Limited surgical resection versus local endoscopic therapy of early cancers of the esophagogastric junction].

BACKGROUND: Adenocarcinomas of the esophagogastric junction (especially Barrett's cancers) are increasingly diagnosed at early stages. The current standard treatment - radical resection with extensive lymphadenectomy - has been challenged. Limited resection or endoscopic mucosal ablation have been proposed as less invasive alternatives. METHODS: Available data regarding limited surgical resections and endoscopic interventional procedures are evaluated with respect to short- and long-term results (mortality, morbidity, oncologic adequacy, quality of life). RESULTS: Limited resection of the esophagogastric junction has been proven as safe (low morbidity and mortality) and oncologically adequate procedure (low rate of recurrence/excellent long-term survival) with good quality of life. The procedure meets the oncological requirements (R0-resection, complete resection of potentially tumor-infiltrated lymph nodes and the entire precancerous Barrett's esophagus). Reconstruction with interposition of a pedicled isoperistaltic jejunal loop prevents reflux and is crucial for achieving good postoperative quality of life. In contrast, endoscopic mucosal resection (EMR) carries the risk of high recurrence rates (at least 30 %). This has to be regarded as an effect of the frequent incomplete resection, multicentric tumor growth, the persistence of precancerous Barrett's mucosa and persistence of gastroesophageal reflux. Consequently, from the oncological view point, EMR is only suited for unicentric mucosal tumors (T1a) in short segments of Barrett's esophagus. Reliable preoperative identification of such tumors is, however, currently not possible. CONCLUSION: For adequately selected patients with early Barrett's cancer, limited resection of the esophagogastric junction is an appropriate procedure. Endoscopic mucosa resection (EMR) might gain importance as staging tool.

Adenocarcinoma↗
PubMed2001

[Liver metastases--primary or multimodal therapy?].

Multimodal therapeutic concepts for the treatment of liver metastasis are currently undergoing evaluation--prompted by the fact that few patients have lasting benefit from resection alone. Thus, for example, in practice, virtually only metastases from colorectal carcinoma or neuroendocrine tumors can be referred to surgical treatment, and, of these, only 20-25% are technically resectable. Furthermore, even after an R0 resection, recurrent disease subsequently develops in 60-75% of the cases. In primarily non-resectable colorectal liver metastases, prior systemic treatment with 5-FU/folinic acid and oxaliplatin can result in partial or complete remission in 50-60% of cases and, depending on patient selection criteria, a secondary R0 resection rendered possible in 14-38%. Theoretical oncological considerations suggest that neoadjuvant treatment should be applied in the case of resectable liver metastases too. The question of whether the prognosis is then improved compared with resection alone is currently being investigated in a prospective multicentre study conducted by the EORTC. The value of adjuvant therapy administered with the aim of lowering the risk of recurrence following "curative" resection of liver metastases is presently not considered to have been adequately demonstrated. With regard to the efficacy of regional chemotherapy, the results of two prospective randomized studies are contradictory. Nor can the multimodal approach decisively improve the outcome of non-radical resection of metastatic lesions. This means that primary or secondary resection with a margin of clearance continues to represent the gold standard for the treatment of colorectal liver metastases. Neoadjuvant or adjuvant chemotherapy--where applicable with the additional use of various methods of thermal ablation (cryotherapy, laser therapy, high-frequency thermotherapy)--should be restricted to clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Study on small hepatocellular carcinoma and its extension.

This paper summarizes the "study on small hepatocellular carcinoma and its extension" in Liver Cancer Institute, Zhongshan Hospital of Shanghai Medical University during the past 25 years. The results indicated that it was an important approach to obtain long-term HCC survivors, of the 239 patients with 5-year survival, small HCC resection accounted for 51.4%. It was an effective approach to improve the prognosis of HCC in the entire series, the 5-year survival of inpatients treated in authors' institution was 4.8% in 1958-1970, 12.2% in 1971-1983, and 46.7% in 1984-1995; which were correlated to the increase proportion of small HCC resection in the series; it was more effective as compared to large HCC resection, the 5 year survival was 61.3% (n = 645) versus 33.6% (n = 950). Extensions of small HCC study included early detection and treatment of small recurrent HCC, of the 147 patients with re-resection, the 5-year survival was 48.9% calculated from the time of first resection. Another extension was conversion of large HCC into small HCC, using multimodality combination treatment, 72 out of the 663 patients with surgically verified unresectable HCCs have been converted to resectable, 5-year survival being 62.1%, which was comparable to that of small HCC resection. Studies on related basic aspect of small HCC such as cell origin of recurrence, and molecular aspect of small HCC, indicated that biological characteristics, particularly the tumor invasiveness, remained the key link for further prolong survival after small HCC resection. Recently, a "patient-like" human HCC metastatic model in nude mice has been established. Experimental interventions have also been tried. Clinical trials for prevention of recurrence after small HCC resection have shown preliminary encouraging results. However, the "cost-effectiveness" of screening, the invasiveness of HCC, the multicentric origin, the coexisted Child C cirrhosis, etc., remained great challenge.

Animals↗
PubMed2006

Pre and postoperative quantitative detection of fragments of cytokeratins 8 and 18 (UBC IRMA) as markers of early recurrence of superficial bladder tumor.

OBJECTIVES: The Urinary Bladder Cancer (UBC) test is a marker that detects urinary fragments of cytokeratin 8 and 18. The aim of this study is to evaluate the usefulness of the pre and post operative UBC test to detect early recurrences of a bladder tumor in the first year after the transurethral resection of a bladder tumor. MATERIALS AND METHODS: A multicentric perspective study on 36 patients with superficial bladder cancer (pTa-pT1) treated with transurethral resection (TUR) was performed. Each patient underwent 4 specific urine collections: 1) preoperatively, 2) 3 days after TUR, 3) 7 days after TUR, 4) 30 days after TUR. UBC was analysed on urine with the IRMA method and the cut off value of 12 mg/L was used. Cystoscopy was performed after 3, 6, 9, and 12 months after TUR, with the aim of identifying all cancer recurrences in the first year postoperatively. Statistical analyses to identify differences between patients with or without early recurrence were performed in accordance with Fisher's exact test and Chi-square analysis. RESULTS: Of the 36 patients included in the study 15 showed early recurrence and 21 were recurrence free 1 year after surgery. UBC levels measured in recurrence free patients 30 days after TUR showed normal values, values decreasing as compared with preoperative levels or both circumstances, even if a statistically significant difference was not found between the two groups. CONCLUSIONS: In this study we reported an insignificant correlation between the postoperative modifications of UBC levels and the risk of tumor recurrence during the first year of follow-up. A larger study group with longer follow-ups will probably allow better evaluation of the real power of UBC tests in clinical practice.

Aged↗
PubMed2001

Current status of liver transplantation for treatment of hepatocellular carcinoma.

Hepatocellular carcinoma accounts for more than 5% of all malignancies with a continuous increase worldwide. The most important risk factor is liver cirrhosis, frequently associated with hepatitis B virus or hepatitis C virus infection. Liver resection is the only treatment that can potentially achieve cure. In carefully selected patients with a tumor smaller than 5 cm the 5-year survival is around 50%. The presence of liver cirrhosis and portal hypertension limits the feasibility of hepatic resection. Child-Pugh A patients without major associated risk factors may be considered as the ideal target group for resection. A significant local disease recurrence rate of more than 70% at 5 years is the main problem of hepatic resection. Orthotopic liver transplantation offers the possibility of removing a potentially multicentric tumor and the underlying end-stage liver disease. Due to pure selection of suitable candidates the initial reports on the efficacy of liver replacement in a cohort of patients with hepatocellular carcinoma were disappointing. Taking the shortness of donor organs and the high posttransplant tumor recurrence rate into account, several groups developed criteria qualifying transplantation. A tumor size of >6 cm and gross intrahepatic portal vein involvement seem to be of significant prognostic importance. Patients with smaller solitary tumors or less than 3 tumors with a total tumor diameter of <8 cm have the same survival after transplantation as those with benign liver disease. Living donor liver transplantation offers a new approach to overcome the organ shortage and to theoretically extend the indication for transplantation in hepatocellular carcinoma.

Carcinoma, Hepatocellular↗
PubMed1975

Effect of quinidine on maintaining sinus rhythm after conversion of atrial fibrillation or flutter. A multicentre study from Stockholm.

In a controlled study comprising 176 patients, quinidine in the form of Kinidin Durules was found to reduced significantly the recurrence of the atrial fibrillation during a 1-year follow-up period after successful electric shock conversion. After one year, 51 per cent (52/101) of the patients in the quinidine group, and 28 per cent (21/75) in the control group remained in sinus rhythm (P smaller than 0.001). No less than 43 per cent of the patients converted to sinus rhythm during treatment with maintenance doses of quinidine sulphate before intended DC conversion. Gastrointestinal side-effects were not uncommon, and caused interruption of quinidine treatment in some cases.

Adult↗
PubMed1999

The management of unicentric and multicentric Castleman's disease: a report of 16 cases and a review of the literature.

BACKGROUND: Castleman's disease (CD), or angiofollicular lymph node hyperplasia, creates both diagnostic and therapeutic dilemmas for most physicians. For patients with this rare and poorly understood disease, the optimal therapy is unknown. The authors report their experience during the years 1986-1997 with this uncommon clinicopathologic entity. METHODS: Sixteen patients with a histologic diagnosis of CD were identified in the pathology database. Unicentric disease was defined as a solitary mass. Multicentric disease compromised patients with widespread lymphadenectomy. Clinical, radiologic, and laboratory data were analyzed to evaluate treatment response. RESULTS: The study group consisted of 16 patients classified into 3 clinicopathologic groups: hyaline-vascular, plasma cell, and "mixed." Of those patients who underwent complete surgical excision of a unicentric hyaline-vascular CD mass (n = 8), all remain symptom free without clinical or radiographic recurrence. Two patients remain asymptomatic following partial resection or radiation therapy for an unresectable unicentric hyaline-vascular CD mass. Two patients with multicentric hyaline-vascular CD are currently in complete remission following adjuvant therapy. Multicentric plasma cell CD was present in a single patient. This patient (who underwent surgical and systemic therapy) died of disease within 4 months of presentation. Three patients with unicentric hyaline-vascular/plasma cell-CD remain symptom free following either complete resection or observation. CONCLUSIONS: The authors recommend surgical resection for patients with the unicentric variant of CD. Surgical removal of a unicentric mass of hyaline-vascular or hyaline-vascular/plasma cell type is curative. Partial resection, radiotherapy, or observation alone may avoid the need for excessively aggressive therapy. Patients with multicentric disease, either hyaline-vascular or plasma cell type, do not benefit from surgical management and should be candidates for multimodality therapy, the nature of which has yet to be defined.

Adult↗
PubMed1995

The effects of 3g eicosapentaenoic acid daily on recurrence of intrauterine growth retardation and pregnancy induced hypertension.

OBJECTIVE: To study the effects of addition of 3 g eicosapentaenoic acid daily to the diet, on recurrence rate of intrauterine growth retardation and pregnancy induced hypertension in a high risk population. DESIGN: Prospective, double blind, randomised multicentre study. Eicosapentaenoic acid or placebo were given from 12 to 14 weeks of gestation onwards. SETTING: University Hospital and regional hospitals in the north of the Netherlands. SUBJECTS: Sixty-three women with a history of intrauterine growth retardation (birthweight < 10th centile) with or without pregnancy induced hypertension in the previous pregnancy. MAIN OUTCOME MEASURES: Birthweight centiles and signs of pregnancy induced hypertension in current pregnancy. RESULTS: One-third of the women developed pregnancy induced hypertension and one-third of the infants had a birthweight below the 10th centile. There were no differences between eicosapentaenoic acid and placebo group. CONCLUSION: Addition of 3 g eicosapentaenoic acid daily does not prevent recurrence of intrauterine growth retardation or pregnancy induced hypertension in a high risk population.

Birth Weight↗
PubMedDate not supplied

Future prospects in limited surgery for early breast cancer.

There is a strong body of opinion that favours conservative surgery in early breast cancer, with certain provisos. If an operation that is less than a mastectomy is to be performed, it is essential that by histological assessment, the resection margins be > or = 10 mm clear, preferably 20 mm. Extensive DCIS is a serious stumbling block, as it suggests the possibility of multicentricity. It would seem that postoperative radiotherapy is always indicated on the grounds of an unacceptable local recurrence rate and thus an expression of a later higher risk of distant metastases. Because of the fact that recurrence both local and distant, are expressed by the nodal state, it is essential to assess the axillary lymph nodes. If they are positive, there are two choices, namely total axillary clearance or postoperative axillary radiotherapy; opinion is divided as to the best management. Because of the good prognosis in well treated pT1pN0 patients, it appears logical to offer these patients conservative surgery, postoperative radiotherapy and adjuvant therapy. The complications of this therapy are far outweighed by the advantage of a cure. In the node-positive patient, it is essential to offer the triumvirate of treatment, surgery, radiotherapy and adjuvant therapy (chemotherapy and tamoxifen) to try and reduce local and regional recurrence and distant metastases.

Axilla↗
PubMed1992

Familial cardiac myxoma.

The majority of cardiac myxomas occur sporadically as isolated lesions in the left atrium of middle-aged women. However, a "familial" form and a "syndrome" form of this lesion have been identified. The syndrome myxoma can present with pigmented skin lesions and peripheral or endocrine neoplasms. The familial and syndrome forms of cardiac myxomas can usually be distinguished from the sporadic form by the presentation at a younger age, the unusual location and multicentricity of the lesions, and the presence of rare pathological conditions. In addition, a higher rate of recurrent lesions is usually associated with the familial and syndrome forms of this disease. To date, 15 families with cardiac myxomas have been reported in the world's literature. Here we present 2 additional case reports.

Adolescent↗
PubMed2004

BRAF mutations in an Italian cohort of thyroid cancers.

OBJECTIVE: Recently, a somatic point mutation of the BRAF gene (V599E) has been identified as the most common genetic event in papillary thyroid carcinoma (PTC) with a variable frequency (about 25-70%) in different series from USA, Japan, Portugal and Ukraine. DESIGN: In the present study, the genetic analysis of BRAF in an Italian cohort of 65 thyroid tumours with corresponding normal tissues and 21 thyroid benign disorders is reported. METHODS: For BRAF analysis, the somatic DNA was PCR amplified by means of specific intronic primers and PCR products were directly sequenced. Statistical analyses were obtained by means of Fisher's exact test. RESULTS: All mutations detected involved a T > A transversion at 1796 (V599E) and were heterozygous. Overall, BRAF(V599E) mutation was found in 18/56 (32.1%) PTCs. According to the histological type of the tumour, the mutation was present in 38.3% of cases of conventional PTC (18/47), in 0/6 follicular variant of PTC, in 0/3 oncocytic variant of PTC. No BRAF mutations were detected either in five follicular carcinomas, or in four poorly differentiated or undifferentiated cancers or in benign thyroid disorders. No statistically significant correlation of BRAF mutation with patient age and gender, with multicentricity of the tumour, with the lymphocytic infiltration of the tissue, with the stage and with the recurrence rate, was found. BRAF(V599E) tended to be associated, although not significantly, with a greater volume and extension of the tumour and with lymph-nodal metastases at surgery. CONCLUSIONS: In conclusion, the present study on the first Italian series of thyroid cancers shows a frequency of 38.3% of BRAF(V599E) in the classical variant of PTC, confirming the key role of this mutation in promoting tumourigenesis.

Adult↗
PubMed1988

Roxatidine acetate in the long term maintenance of duodenal ulcers.

A non-comparative multicentre study of 105 patients with healed duodenal ulcers was conducted to determine the effect on ulcer recurrence of 6 months' maintenance treatment with roxatidine acetate 75 mg daily. All patients had previously received roxatidine acetate treatment. 31 patients out of 89 had 32 relapsed ulcers after 6 months of treatment, which represents an overall relapse rate of around 30%; the relapse rate in smokers was double that of non-smokers. The overall incidence of epigastric pain did not increase significantly over the period of the trial, although some patients complained of mild pain when they entered the study despite having endoscopically confirmed healed ulcers. At the end of the study continuous poor appetite and pyrosis were reported by 17% and 6% of patients, respectively. Side effects, which included constipation and diarrhoea, were reported by 4 patients, 1 of whom withdrew from therapy. There were no clinically significant changes in laboratory values. Thus, maintenance treatment with roxatidine acetate 75 mg daily proved a safe and effective method of preventing symptomatic duodenal ulcer relapse.

Adult↗
PubMed1988

[The recurrence of bladder cancer in the glans and fossa navicularis of urethra following cystectomy].

A 42-year-old male was admitted to our Hospital. Diagnosis of invasive bladder cancer was made and a total cystectomy was carried out on September 14, 1982. Histological examination showed transitional cell carcinoma, grade II-III, pT2N0M0. After cystectomy, the patient was treated with a combination chemotherapy of cis-platinum, cyclophosphamide, adriamycin and 5-fluorouracil. After 3 years, he noticed an area of reddish and painless rashes around the urethral meatus. A biopsy of the skin lesion showed a nest formation of transitional cell carcinoma with lymphocyte infiltration under the squamous epithelium. A urethrectomy was carried out on January, 28, 1986. A histologic study established the diagnosis of recurrent transitional cell carcinoma. The pathological process seemed to be a result of hematogenous metastasis rather than multicentricity or implantation.

Adult↗
PubMedDate not supplied

111In octreotide scintigraphy in the evaluation of head and neck lesions.

PURPOSE: To evaluate indium 111 octreotide scintigraphy for the detection of suspected neuroendocrine lesions of the head and neck. METHODS: After receiving 6 mCi of 111In octreotide, 22 patients with suspected lesions of the head and neck were examined with both planar and single-photon emission CT (SPECT). Static images, obtained at 4 hours, included the head/neck, chest, abdomen, and pelvis. Additional SPECT images were obtained at 4 or 24 hours. Studies were compared with available conventional radiologic examinations (12 CT, 11 MR, and three angiographic studies) as well as with clinical and pathologic findings. RESULTS: Eighteen of the 22 patients had abnormal findings at scintigraphy. Eleven paragangliomas were seen in 10 patients, metastatic medullary thyroid carcinoma in three patients, thyroid adenoma in two patients, and Merkel cell tumor, carcinoid, and plasmacytoma in one patient each. Surgical confirmation was available in 13 patients. The smallest lesion detected was 1.5 cm. There was one false-positive and one false-negative examination. CONCLUSION: 111In octreotide scintigraphy is a useful imaging tool for the detection of primary and metastatic neuroendocrine tumors of the head and neck that are larger than 1.5 cm. This technique enables distinction of glomus tumors from other masses (such as neuromas) and can be used in the postoperative setting to distinguish scar from recurrent paraganglioma. Since it is an examination of the entire body, it has great utility for detecting multicentric paraganglioma and for screening patients with familial paraganglioma.

Adult↗
PubMed1982

Duct carcinoma in situ. Relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures.

Fifty-three breasts resected for a biopsy diagnosis of duct carcinoma in situ were studied with a serial subgross and correlated radiographic method of examination designed to permit quantitation of the extent of the noninvasive lesion in the breast. Overall frequencies of occult invasion and multicentricity were 21 and 32%, respectively. Among 24 lesions 25 mm or larger in extent (average, 63; median, 56 mm) 11 showed occult foci of invasion, 13 had multicentric foci and six had nipple involvement. Among 29 lesions less than 25 mm in extent (average, 10; median, 8 mm) there were no instances of occult invasion, four were multicentric and two had nipple involvement (P = less than 0.05 for multicentricity and occult invasion). Twenty patients with lesions averaging 8 mm in extent are being followed after excision only in an experimental program. There have been three local recurrences at an average follow-up of 44 months. All recurrences occurred ipsilaterally, two were within the prior biopsy site. All patients with recurrence are free of disease following local resection in two and modified radical mastectomy in one. For lesions with associated microcalcifications, the distribution of the mammographic microcalcifications closely approximates the extent of disease as confirmed histologically. These findings suggest that an important predictive factor for the presence of occult invasion and multicentricity in the resected breast is the extent of the noninvasive lesion.

Adolescent↗
PubMed1996

The Italian Registry for Adrenal Cortical Carcinoma: analysis of a multiinstitutional series of 129 patients. The ACC Italian Registry Study Group.

BACKGROUND: Adrenal cortical carcinoma is an uncommon tumor with a poor prognosis. The low incidence of this tumor makes it difficult to achieve reliable data on clinical manifestations, natural history, and the impact of therapies. The purpose of this study was to evaluate such aspects in a large series. METHODS: A retrospective series of 129 cases (55 men and 74 women, mean age of 49 years) was collected from 18 surgical institutions. At the time of diagnosis 45.7% of patients had endocrine symptoms. One hundred twenty-four patients underwent surgery, which was considered curative in 91 cases and palliative in 33. Sixty-three patients had local disease, 48 had regional disease, and 43 had distant metastases. RESULTS: This study confirmed a higher incidence in the 40- to 50-year-old population with a female prevalence; hormonal hyperincretion was more common in women, but it was not caused by advanced disease. The overall 5-year survival rate was 35%. Tumor stage and curative resection affected prognosis significantly. The influence of gender, side, age, and hormonal function has not been confirmed. Adjuvant therapies were ineffective in prolonging survival. Reoperated patients experienced better survival (mean, 41.5 months) than nonreoperated cases (mean, 15.6 months). CONCLUSIONS: The poor prognosis of adrenal cortical carcinoma may be improved by early diagnosis and complete resection. Radical surgery is the sole effective therapy, particularly in early stages. Surgical treatment of recurrence seems to improve survival and should be attempted systematically. Adjuvant therapies obtained contrasting results, and their role should be evaluated in prospective multicentric trials.

Actuarial Analysis↗